Benussi Stefano, MD PhD
Division of Cardiac Surgery - Spedali Civili di Brescia
University of Brescia Medical School
P.le Spedali Civili 1,
25123 Brescia, Italy
Phone: +39 030 399 6401
Fax: +39 030 399 5004
Email Address:stefano.benussi@unibs.it
Stefano Benussi is consultant/proctor for Atricure, Allergan, and Cryolife.
Other authors: No conflict of interest to disclose.
Funding: (None)
ABSTRACT INTRODUCTION
Situs inversus totalis, dextrocardia with interrupted inferior vena cava and azygos vein continuation concomitant with symptomatic atrial fibrillation requiring ablation. This case was deemed not suitable for percutaneous ablation due to anatomic variations and the lack of case reports in literature.
METHODS AND RESULTS
We performed bilateral thoracoscopic epicardial ablation and epicardial left atrial appendage exclusion. The direct vision allowed for a complete box lesion set with bipolar radiofrequency device. Patient remained in sinus rhythm at 12-months follow-up.
CONCLUSION
Surgical thoracoscopic epicardial ablation is safe and effective also in congenital defects. Multidisciplinary expertise can offer minimally invasive ablation treatments.
KEYWORDS
Atrial fibrillation, radiofrequency ablation, surgical thoracoscopic ablation, minimally invasive, left atrial appendage, left atrial appendage exclusion, situs inversus totalis, dextrocardia, interrupted inferior vena cava
INTRODUCTION Concomitant long-persistent atrial fibrillation in a rare congenital aberration: situs inversus totalis, dextrocardia with interrupted inferior vena cava and azygos vein continuation. This case was deemed not suitable for percutaneous ablation due to anatomic variations and the lack of case reports in literature. METHODS AND RESULTS We performed surgical thoracoscopic epicardial ablation and concomitant left atrial appendage exclusion. Thanks to direct vision, the complete box lesion was performed with radiofrequency. At twelve months patient remained in sinus rhythm. CONCLUSION Surgical thoracoscopic epicardial ablation is safe and effective also in congenital defects. Multidisciplinary expertise can offer minimally invasive ablation treatments.
KEYWORDS: Atrial fibrillation, radiofrequency ablation, surgical thoracoscopic ablation, left atrial appendage, left atrial appendage exclusion, congenital defects, situs inversus totalis, dextrocardia, interrupted inferior vena cava